Traumatic Brain Injury in Mumbai: A Survey of Providers along the Care Continuum

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Traumatic Brain Injury in Mumbai: A Survey of Providers along the Care Continuum


JournalAsian Journal of Neurosurgery
Article typeJournal research article – Clinical research
Publication date – Aug – 2020
Authors – Saksham Gupta, Monty Khajanchi, Harris Solomon, Nakul P. Raykar, Blake C. Alkire, Nobhojit Roy, Kee B. Park, and Vineet Kumar
KeywordsBarriers to Care, Low-and middle-income countries, mortality, traumatic brain injury, urbanization
Open access – Yes
SpecialityAnaesthesia, Neurosurgery, Trauma and orthopaedic surgery, Trauma surgery
World region South-eastern Asia
Country: India
Language – English
Submitted to the One Surgery Index on November 19, 2020 at 3:08 pm
Abstract:

Introduction:
Traumatic brain injury (TBI) represents a significant burden of a global disease, especially in low- and middle-income countries (LMICs) such as India. Efforts to curb the impact of TBI require an appreciation of local factors related to this disease and its treatment.

Methods:
Semi-structured qualitative interviews were administered to paramedics, anesthesiologists, general surgeons, and neurosurgeons in locations throughout Mumbai from April to May 2018. A thematic analysis with an iterative coding was used to analyze the data. The primary objective was to identify provider-perceived themes related to TBI care in Mumbai.

Results:
A total of 50 participants were interviewed, including 17 paramedics, 15 anesthesiologists, 9 general surgeons, and 9 neurosurgeons who were involved in caring for TBI patients. The majority of physicians interviewed discussed their experiences in public sector hospitals (82%), while 12% discussed private sector hospitals and 6% discussed both. Four major themes emerged: Workforce, equipment, financing care, and the family and public role. These themes were often discussed in the context of their effects on increasing or decreasing complications and delays. Participants developed adaptations when managing shortcomings in these thematic areas. These adaptations included teamwork during workforce shortages and resource allocation when equipment was limited among others.

Conclusions:
Workforce, equipment, financing care, and the family and public role were identified as major themes in the care for TBI in Mumbai. These thematic elements provide a framework to evaluate and improve care along the care spectrum for TBI. Similar frameworks should be adapted to local contexts in urbanizing cities in LMICs.

OSI Number – 20772
PMID – 33145217

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